Patients don’t get orders as process is smoothed 

Illegible, lost prescriptions not an issue 

Southern Ohio Medical Center in Portsmouth has streamlined the process where a physician’s order becomes a scheduled appointment for the patient, and improved its customer satisfaction in the bargain. Rather than giving the order for an outpatient test or procedure to each patient as he or she leaves the office, the physicians’ staff are asked to hold those orders until the end of the day, explains Pamela Partlow, RN, manager of registration and central scheduling. 

Clarify information 

The physician’s staff make sure all the patient’s demographic information is there and that there is medical necessity. It then batches all of the day’s orders to the hospital by fax or courier, Partlow adds. "We ask them not to give the order to the patient because the patient [often] loses it or can’t read what the test is," Partlow says. When that happens, her staff have to call the physician to clarify the information. By that time, the physician might not remember who the patient is, she adds. Patients who show up without the order, meanwhile, must wait until registration employees contact the physician’s office and have another order faxed over, Partlow points out. With the new process (which the 350-bed hospital began piloting in January 2001), patients are given a bright-green card with the telephone number for central scheduling, she says. The card instructs the patient to call the number within two to three days, Partlow adds. If the patient doesn’t call to arrange an appointment within a week, registration staff make three attempts to contact the patient, she says. "If [the patient] refuses to have the test or doesn’t return the calls, we document all that on the order," Partlow explains, "and send it back to the physician’s office for their files." To facilitate the process, the hospital hired seven employees and now offers central scheduling services between 7 a.m. and 11 p.m., she says. The impetus for that substantial investment was customer service, Partlow adds. "Patients [had been] very dissatisfied with coming in and having to wait an hour to get registered for an outpatient procedure. Then they would have to go to the department [where the procedure was to be performed] and wait about another hour. That’s been cut down greatly, too." To make the handling of orders more efficient, she notes, the hospital provides free outpatient order forms to physicians. "That way, when they batch [the orders], they are all the same. Many physicians just use [prescription pads] to write the orders, but our forms include all the tests; they can just make a check mark by the appropriate one." 

The reason all this has been worthwhile, Partlow says, is that patient satisfaction has dramatically increased. "Now the patient just walks up and is already preregistered. They don’t have to wait, and we don’t have to make numerous calls because someone forgot the order." In addition, she says, the outpatient departments know that at a particular time, a certain number of patients are scheduled to have a certain procedure, so departments can staff accordingly. Before, patients could just walk in without an appointment and present an order for a basic lab test or X-ray. The departments didn’t know how many patients to expect, Partlow notes. Even procedures such as CAT scans and cardiac tests were done on a walk-in basis, she adds. Since the pilot program began in January, the hospital’s policy is that all outpatient tests — including complete blood counts — are scheduled by the patient through central scheduling, Partlow says. The results have been gratifying, she adds, with most waits reduced to two or three minutes. In addition to increasing patient satisfaction and reducing the number of lost orders and phone calls to the physician offices, the new process offers physician staffs a check-and-balance system, she points out. "When we schedule an appointment, we fax [the physician office] a confirmation form so they can see if they ordered the right test," Partlow says. "Also, that confirmation has the date and the time of the test so they know when they should be getting the results." This fax-back confirmation feature is an optional part of the process, she notes. Of the 100-plus physician practices in the area, Partlow says, about 30 participate in the new process. 

To promote cooperation and compliance from the physician practices, Southern Ohio Medical Center hosts a quarterly "registration and central scheduling informational breakfast meeting," she notes. Although the breakfast meeting was established before she joined the department four years ago, Partlow says, attendance has increased dramatically since she began promoting it. The breakfast now draws between 90 and 100 attendees, she notes. Her theory, Partlow says with a laugh, is, "If you feed them, they will come." The staffs of all physician offices and nursing homes in the area are invited, she says, and the audience may include nurses, office assistants, unit clerks, and nursing home administrators. Also attending in addition to herself are the supervisors for registration and central scheduling. "We may have other department directors or supervisors," Partlow adds. "For example, the director of the cardiac lab [did a presentation on] how to prep patients before a cardiac test, and the correct way to explain things to the patient." As part of another program, she says, a physician discussed mammograms and breast cancer, and the supervisor of the breast center explained the difference between a screening mammogram and a diagnostic mammogram. That distinction, Partlow notes, is a medical necessity issue and should be addressed during the registration process. "Medical necessity has been a big [topic] lately," she adds. "We’ve gone over with [physician staff] the need to have a diagnosis on the test ordered. If they have a question, they ask at the meeting, or they call later. It’s a share of information back and forth."